Association between initial vascular access and survival in hemodialysis according to age

BACKGROUND/AIMS: This study aims to demonstrate whether the association between initial vascular access and mortality among hemodialysis patients varies by age. METHODS: We conducted a retrospective study that included 2,552 patients who started hemodialysis. Vascular access was divided into three categories: percutaneous catheter, tunneled cuffed catheter, and arteriovenous (AV) access. RESULTS: Survival rates for patients who received a central venous catheter, such as percutaneous or tunneled cuffed catheter, aged 65 to 74 years and those ≥ 75 years were reduced, but not for those aged < 65 years (log-rank test; p < 0.001, p = 0.007, and p = 0.278). After fully adjusting for potential confounding factors in the patients aged < 65 years, percutaneous and tunneled cuffed catheter were not associated with 5-year mortality. On the other hand, for patients aged 65 to 74 or ≥ 75 years, percutaneous catheter and tunneled cuffed catheter were associated with higher 5-year mortality rates. As age increased, the conversion rate from central venous catheter, including percutaneous catheter and tunneled cuffed catheter, to AV access decreased (94.1%, 90.5%, and 80.3% for patients aged < 65, 65 to 74, and ≥ 75 years, respectively; p < 0.001). CONCLUSIONS: In patients aged ≥ 65 years, initial vascular access was associated with long-term mortality. We suggest that a “fistula first” strategy is superior for elderly patients and demonstrates that it is desirable to change to AV access, and not maintain an initial central vascular catheter.